Ferrlecit

WARNINGS

Included as part of the PRECAUTIONS section.

PRECAUTIONS

Hypersensitivity Reactions

Serious hypersensitivity reactions, including anaphylactic-type reactions,
some of which have been life-threatening and fatal, have been reported in patients
receiving Ferrlecit in post marketing experience. Patients may present with shock, clinically significant hypotension, loss of consciousness, or collapse.
Monitor patients for signs and symptoms of hypersensitivity during and after
Ferrlecit administration for at least 30 minutes and until clinically stable
following completion of the infusion. Only administer Ferrlecit when personnel
and therapies are immediately available for the treatment of anaphylaxis and
other hypersensitivity reactions [see ADVERSE REACTIONS].

In the single-dose, post-marketing, safety study one patient experienced a
life-threatening hypersensitivity reaction (diaphoresis, nausea, vomiting, severe
lower back pain, dyspnea, and wheezing for 20 minutes) following Ferrlecit administration.
Among 1,097 patients who received Ferrlecit in this study, there were 9 patients
(0.8%) who had an adverse reaction that, in the view of the investigator, precluded
further Ferrlecit administration. These included one life-threatening reaction,
six allergic reactions (pruritus x2, facial flushing, chills, dyspnea/chest
pain, and rash), and two other reactions (hypotension and nausea). Another 2
patients experienced (0.2%) allergic reactions not deemed to represent drug
intolerance (nausea/malaise and nausea/dizziness) following Ferrlecit administration.

Hypotension

Ferrlecit may cause clinically significant hypotension. Hypotension associated
with lightheadedness, malaise, fatigue, weakness or severe pain in the chest,
back, flanks, or groin has been reported. These hypotensive reactions may or
may not be associated with signs and symptoms of hypersensitivity reactions
and usually resolve within one to two hours. In the single dose safety study,
post-administration hypotensive events were observed in 22/1,097 patients (2%)
following Ferrlecit administration. Transient hypotension may occur during dialysis.
Administration of Ferrlecit may augment hypotension caused by dialysis. Monitor
patients for signs and symptoms of hypotension during and following Ferrlecit
administration [see ADVERSE REACTIONS].

Iron Overload

Excessive therapy with parenteral iron can lead to excess storage of iron with
the possibility of iatrogenic hemosiderosis. Patients receiving Ferrlecit require
periodic monitoring of hematologic and iron parameters (hemoglobin, hematocrit,
serum ferritin, and transferrin saturation).

Benzyl Alcohol Toxicity

Ferrlecit contains benzyl alcohol as a preservative. Benzyl alcohol has been
associated with serious adverse events and death in pediatric patients. The
minimum amount of benzyl alcohol at which toxicity may occur is not known. Premature
and low-birth weight infants may be more likely to develop toxicity [see Use
in Specific Populations]

Nonclinical Toxicology

Carcinogenesis, Mutagenesis, Impairment of Fertility

Long term carcinogenicity studies of sodium ferric gluconate in animals were
not performed.

Sodium ferric gluconate was not genotoxic in the Ames test or the rat micronucleus
test. Sodium ferric gluconate produced a clastogenic effect in an in vitro
chromosomal aberration assay in Chinese hamster ovary cells.

Studies to assess the effects of sodium ferric gluconate on fertility were
not conducted.

Use In Specific Populations

Pregnancy

Pregnancy Category B

There are no adequate and well-controlled studies with Ferrlecit in pregnant
women. Reproduction studies have been performed in mice at doses up to 100 mg/kg/day
(300 mg/m²/day) and in rats at up to 20 mg/kg/day (120 mg/m²/day).
The doses in mice and rats are 4 and 1.5 times the human dose of 125 mg/day
(77 mg/m²/day) on a body surface area basis and have revealed no evidence
of harm to the fetus due to Ferrlecit. Because animal reproduction studies are
not always predictive of human response, this drug should be used during pregnancy
only if clearly needed.

Ferrlecit contains benzyl alcohol as a preservative. There are no known adverse
outcomes associated with fetal exposure to the preservative benzyl alcohol through
maternal drug administration; however, the preservative benzyl alcohol can cause
serious adverse events and death when administered intravenously to neonates
and infants.

Nursing Mothers

It is not known whether Ferrlecit is excreted in human milk. Benzyl alcohol
present in maternal serum is likely to cross into human milk and may be orally
absorbed by a nursing infant. Caution should be exercised when Ferrlecit is
administered to a nursing woman.

Benzyl Alcohol Toxicity and Pediatrics

The preservative benzyl alcohol has been associated with serious adverse events
and death in pediatric patients. The “gasping syndrome” (characterized
by central nervous system depression, metabolic acidosis, gasping respirations,
and high levels of benzyl alcohol and its metabolites found in the blood and
urine) has been associated with benzyl alcohol dosages > 99 mg/kg/day in neonates
and low-birth weight infants. Additional symptoms may include gradual neurological
deterioration, seizures, intracranial hemorrhage, hematologic abnormalities,
skin breakdown, hepatic and renal failure, hypotension, bradycardia, and cardiovascular
collapse.

Although normal therapeutic doses of this product deliver amounts of benzyl
alcohol that are substantially lower than those reported in association with
the “gasping syndrome”, the minimum amount of benzyl alcohol at
which toxicity may occur is not known. Premature and low-birth weight infants,
as well as patients receiving high dosages, may be more likely to develop toxicity.
Practitioners administering this and other medications containing benzyl alcohol
should consider the combined daily metabolic load of benzyl alcohol from all
sources.

Geriatric Use

Clinical studies of Ferrlecit did not include sufficient numbers of subjects
aged 65 and over to determine whether they respond differently from younger
subjects. Other reported clinical experience has not identified differences
in responses between the elderly and younger patients, In general, dose selection
for an elderly patient should be cautious, usually starting at the low end of
the dosing range, reflecting the greater frequency of decreased hepatic, renal,
or cardiac function, and of concomitant disease or other drug therapy.

Last reviewed on RxList: 8/31/2011
This monograph has been modified to include the generic and brand name in many instances.